Eficácia de la Terapia Cognitiva Conductual Para el Trastorno Bipolar: una Revisión Sistemática

Introducción: El trastorno bipolar (TB) es una enfermedad mental grave con un curso crónico y una morbimortalidad importante. El TB tiene una tasa de prevalencia a lo largo de la vida del 1 al 1,5% y se caracteriza por episodios recurrentes de manía, depresión o una mezcla de ambas fases. Aunque tiene tratamiento farmacológico y psicoterapéutico, la terapia cognitiva conductual (TCC) ha mostrado efectos beneficiosos, pero no se cuenta con suficiente información clínica en la literatura actual. Métodos: El objetivo principal es determinar la eficacia de la TCC sola o como complemento del tratamiento farmacológico para el TB. Se realizó una revisión sistemática de 17 artículos. Los criterios de inclusión fueron: investigación cuantitativa o cualitativa dirigida a examinar la eficacia de la TCC en pacientes con TB con/sin medicación, publicaciones en idioma inglés y tener 18-65 anos de edad. Los criterios de exclusión fueron: artículos de revisión y metanálisis, artículos que incluían a pacientes con otros diagnósticos además de TB y no separaban los resultados basados en dichos diagnósticos y estudios con pacientes que no cumplían los criterios de TB del DSM o ICD. Se realizaron búsquedas en las bases de datos PubMed, PsycINFO y Web of Science hasta el 5 de enero de 2020. La estrategia de búsqueda fue: "Bipolar Disorder" AND "Cognitive Behavioral Therapy". Resultados: Se incluyó en total a 1.531 pacientes de ambos sexos. La media de edad ponderada fue 40,703 arios. El número de sesiones varió de 8 a 30, con una duración total de 45-120 min. Todos los estudios muestran resultados variables en la mejora del nivel de depresión y la gravedad de la manía, mejora de la funcionalidad, disminución de recaídas y recurrencias, reducción de los niveles de ansiedad y reducción de la gravedad del insomnio. Conclusiones: Se considera que la TCC sola o complementaria para pacientes con TB muestra resultados prometedores después del tratamiento y durante el seguimiento. Los beneficios incluyen niveles reducidos de depresión y manía, menos recaídas y recurrencias y niveles más altos de funcionamiento psicosocial. Se necesitan más estudios.

Introduction: Bipolar disorder (BD) is a serious mental illness with a chronic course and significant morbidity and mortality. BD has a lifetime prevalence rate of 1% to 1.5% and is characterised by recurrent episodes of mania and depression, or a mixture of both phases. Although it has harmacological and psychotherapeutic treatment, cognitive behaviouraltherapy (CBT) has shown beneficial effects, but there is not enough clinical information in the current literature. Methods: The main aim was to determine the efficacy of CBT alone or as an adjunct to pharmacological treatment for BD. A systematic review of 17 articles was carried out. The inclusion criteria were: quantitative or qualitative research aimed at examining the efficacy of CBT in BD patients with/without medication; publications in English language; and) being 18-65 years of age. The exclusion criteria were: review and meta-analysis articles; articles that included patients with other diagnoses in addition to BD and that did not separate the results based on such diagnoses; and studies with patients who did not meet the DSM or ICD criteria for BD. The PubMed, PsycINFO and Web of Science databases were searched up to 5 January 2020. The search strategy was: "Bipolar Disorder" AND "Cognitive Behavioral Therapy". Results: A total of 1,531 patients both sexes were included. The weighted mean age was 40.703 years. The number of sessions ranged from 8-30, with a total duration of 45120 minutes. All the studies show variable results in improving the level of depression and the severity of mania, improving functionality, reducing relapses and recurrences, and reducing anxiety levels and the severity of insomnia. Conclusions: The use of CBT alone or adjunctive therapy in BD patients is considered to show promising results after treatment and during follow-up. Benefits include reduced levels of depression and mania, fewer relapses and recurrences, and higher levels of psychosocial functioning. More studies are needed.

Masturbación compulsiva en adolescente / Compulsive Masturbation in Adolescents

Introducción: La masturbación compulsiva provoca una cascada de sentimientos y emociones que pueden recorrer desde la culpabilidad y el rechazo a la satisfacción hasta el bienestar más placentero y deseado. Objetivo: Exponer una forma de presentación poco frecuente de un adolescente con masturbación compulsiva. Presentación del caso: Adolescente masculino de 14 años de edad, de procedencia rural y antecedentes de salud física. Evaluado en consulta de psiquiatría infanto - juvenil por realizar masturbaciones en sitios públicos, que resultaban cada vez más frecuentes, y al final de esta se producía expulsión de materia fecal. Los estudios clínicos y psicométricos confirmaron el diagnóstico de masturbación compulsiva. Conclusiones: El tratamiento se basó en el modelo cognitivo-conductual y farmacológico con imipramina. Se disminuyó la frecuencia e intensidad, así como la duración de la conducta problema. El caso clínico expuesto resulta de interés por ser poco frecuente la presencia de este trastorno dentro de la población adolescente(AU)

Introduction: Compulsive masturbation provokes a cascade of feelings and emotions that can range from guilt and refusal to satisfaction to the most pleasurable and desired well-being. Aim: To present a rare presentation of an adolescent with compulsive masturbation. Case presentation: 14-year-old male adolescent from a rural area with a history of previous physical health. He was evaluated in a child and adolescent psychiatry clinic for masturbation in public places, which became increasingly frequent and ended with the expulsion of fecal matter. Clinical and psychometric studies confirmed the diagnosis of compulsive masturbation. Conclusions: Treatment was based on the cognitive-behavioral and pharmacological model with imipramine. The frequency and intensity, as well as the duration of the problem behavior was reduced. The clinical case presented was of interest due to the infrequent presence of this disorder in the adolescent population(AU)

Understanding Matters of the Mind in Obesity

@#Obesity is a growing global concern, and Singapore is not spared from the global epidemic. Apart from the increased risk for many serious diseases and health conditions, obese individuals are vulnerable to many psychological comorbidities. Obesity management through lifestyle changes can be limited by various barriers, increasing the challenge of implementation and leaving some clinicians feeling frustrated and stressed. The paper examines the barriers identified in the literature, discusses the use of cognitive behavioural concepts and techniques to facilitate the lifestyle change process and explores the use of motivation and readiness to change to guide the clinician’s strategies.

Impact of a multimodal intervention on the psychological profile of schizophrenic and bipolar I patients: A study of PRISMA programme / Efecto de una intervención multimodal en el perfil psicológico de pacientes con Esquizofrenia y TAB tipo I: Estudio del Programa PRISMA

Abstract Background: Bipolar disorder (BD) and schizophrenia are included in the group of severe mental illness and are main causes of disability and morbidity in the local population due to the bio-psycho-social implications in patients. In the last 20 years or so, adjunctive psychological interventions been studied with the purpose of decreasing recurrences, stablishing the course of the disease, and improving the functionality in these patients. Objective: To analyse the psychological effect of a multimodal intervention (MI) vs a traditional intervention (TI) programme in BD I and schizophrenic patients. Methods: A prospective, longitudinal, therapeutic-comparative study was conducted with 302 patients (104 schizophrenic and 198 bipolar patients) who were randomly assigned to the MI or TI groups of a multimodal intervention programme PRISMA. The MI group received care from psychiatry, general medicine, neuropsychology, family therapy, and occupational therapy. The TI group received care from psychiatry and general medicine. The Hamilton and Young scales, and the Scales for the Assessment of Negative Symptoms (SANS) and Positive Symptoms (SAPS) were used on bipolar and schizophrenic patients, respectively. The scales AQ-12, TEMPS-A, FAST, Zuckerman sensation seeking scale, BIS-11, SAI-E and EEAG were applied to measure the psychological variables. The scales were performed before and after the interventions. The psychotherapy used in this study was cognitive behavioural therapy. Results: There were statistically significant differences in socio-demographic and clinical variables in the schizophrenia and bipolar disorder group. There were no statistically significant differences in the psychological scales after conducting a multivariate analysis between the intervention groups and for both times (initial and final). Conclusion: This study did not show any changes in variables of psychological functioning variables between bipolar and schizophrenic groups, who were subjected to TI vs MI (who received cognitive behavioural therapy). Further studies are needed with other psychological interventions or other psychometric scales.

Resumen Introducción: El Trastorno Afectivo Bipolar (TAB) y la Esquizofrenia están incluidos dentro de las enfermedades mentales severas y hacen parte de las primeras causas de discapacidad y morbilidad en la población local debido al compromiso biopsicosocial en los pacientes. En las últimas décadas se han estudiado intervenciones psicológicas adjuntas con el fin de prevenir recurrencias, estabilizar el curso de la enfermedad o mejorar la funcionalidad de los pacientes con dichas patologías. Objetivo: Analizar el efecto psicológico de un programa de intervención multimodal (IM) vs la intervención tradicional en sujetos con TAB I y esquizofrenia. Metodología: Se realizó un estudio prospectivo, longitudinal, terapéutico-comparativo, con una muestra de 302 pacientes (104 pacientes con diagnóstico de esquizofrenia y 198 pacientes con TAB) que fueron asignados aleatoriamente a un grupo de IM o IT dentro de un Programa de Salud Mental con énfasis en reducción de la carga, el daño y el gasto social de la enfermedad mental PRISMA. Los pacientes asignados a la IM recibían atención por psiquiatría, medicina general, psicología, neuropsicología, terapia de familia y terapia ocupacional y, los pacientes asignados a IT recibían atención por psiquiatría y medicina general. Las escalas realizadas antes y después de las intervenciones fueron las escalas de Hamilton y Young y, las escalas SANS y SAPS, para pacientes bipolares y esquizofrénicos, respectivamente. Para evaluar las variables psicológicas se aplicaron las escalas AQ-12, TEMPS-A, FAST, Búsqueda de sensaciones de Zuckerman, BIS-11, SAI-E y EEAG. La psicoterapia usada en el componente de psicología fue la terapia cognitivo conductual. Resultados: Se encontraron diferencias estadísticamente significativas en las variables socio-demográficas y clínicas entre el grupo de pacientes con TAB y esquizofrenia. Luego de hacer un análisis multivariado MANCOVA, no se observaron diferencias estadísticamente significativas en los resultados entre el momento inicial y final en los grupos de pacientes TAB y esquizofrenia en ninguna de las escalas aplicadas. Conclusión: El presente estudio no evidenció un cambio a nivel psicológico en los pacientes con TAB y con esquizofrenia que estuvieron bajo IT vs IT (quienes recibieron terapia cognitivo conductual). Futuros estudios aplicando otras psicoterapias adjuntas y usando otras escalas psicométricas podrían ser considerados.

Anxiety Sensitivity and Comorbid Psychiatric Symptoms over the Course of Cognitive Behavioural Therapy for Panic Disorder.

Aims: Anxiety sensitivity (AS) might be the core vulnerability in the pathogenesis of AXIS I diagnosis and might be the important transdiagnostic target for the interventions for comorbid psychiatric symptoms in panic disorder (PD). This study aimed to examine the relationship of changes in the three factors of AS and changes in comorbid psychiatric symptoms over the course of cognitive behavioural therapy (CBT) for PD. Methodology: One hundred eighteen patients with PD were treated with manualized group CBT. Using multiple regression analysis, we examined the associations between the changes in subscales of Symptom Checklist-90 Revised (SCL-90-R) and the changes in factors of the Anxiety Sensitivity Index (ASI) involving Physical Concerns, Mental Incapacitation Concerns, and Social Concerns over the course CBT. Results: Reductions in Mental Incapacitation Concerns of ASI were related to decreases in 8 SCL-90-R scales, including Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism, and GSI. Reductions in Physical Concerns were related to decreases in 5 SCL-90-R scales, including Somatization, Depression, Anxiety, Phobic Anxiety, and GSI. Discussion: The present study suggests that reductions in AS, especially mental and physical dimensions, predict comorbid psychiatric symptoms reduction over the course of CBT for PD.

A Pilot Study of Group Cognitive Behavioural Therapy for Depression in a Japanese Community.

Aims: This pilot study investigated the effect and feasibility of a group cognitive behavioural therapy program in a Japanese community setting. Methodology: Participants were five patients with major depression. Ten weekly 1-hour sessions of group cognitive behavioural therapy was conducted in a Japanese community setting. Outcomes were assessed using the Beck Depression Inventory-II (BDI-II). Statistical comparison of means was performed using nonparametric Wilcoxon signed-rank test using normal approximation, and effect sizes (d) was used to compare depression scores before and after the intervention. Results: Group cognitive behavioural therapy appears to be significantly efficacious in a Japanese community setting, with an effect size of .85. The present results are similar to those found in clinical settings. Discussion: Adapting group cognitive behaviour programs to Japanese community settings can contribute to improved mental health in this country. The limitations of this study are the sample size was very small, measurement is self-reported questionnaire and conducted in a community setting as an uncontrolled, naturalistic pilot study. Controlled studies are needed and would provide a more convincing demonstration of the program’s efficacy in Japanese community settings.

Effect of Group Cognitive Behavioural Therapy with Compassion Training on Depression: A Study Protocol.

Aims: Cognitive behavioural therapy (CBT) is one of the evidence-based treatments for depression. However, some patients high in self-criticism do not respond to CBT. Compassion-focused therapy (CFT) is featured in treating self-criticism and shame, and some trials have reported its effectiveness on depression in individual and group settings. The aim of this study is to adapt an established combined manual of group CBT and CFT, evaluate its efficacy as a pilot study, and discuss the advantages of group CBT (GCBT) program using compassion as a depression therapy in a Japanese community setting. Design and Methods: In this single group study, participants will receive 10 sessions of GCBT with compassion training that was provided through the CFT. All sessions will last for 1 hour and be provided weekly. The outcome measure is the Beck Depression Inventory II, and the secondary outcome is the Self-Compassion Scale in Japanese. Both outcomes will be measured pre- and post-program. The sample size will be 15 participants due to the limited capacity for intervention within the community. Discussion: It is expected that the program will show a larger effect size than that of GCBT reported in previous studies on depression and self-compassion. The results will show an effect size that justifies the introduction of a randomized controlled study to improve the program. Trial Registration: UMIN Clinical Trials Registry 000015007 https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&language=J&recptno=R000016862. Conclusion: CFT or compassion training can augment the treatment of major depression using CBT. Despite several limitations, this clinical trial may help estimate the effectiveness of CFT, which will aid in the design of a further controlled study.

The effectiveness of psychological interventions amongtinnitus sufferers: A review

SUMMARY Introduction: The aim of this article was to review the types of psychological interventions for patients with tinnitus, professionals involved in giving the intervention, the effectiveness of each method of interventions and comparisons with non-psychological approaches in treating tinnitus. Materials and Methods: PubMed database searched. Results: Twenty one articles that employed randomized controlled trials design were included. Cognitive behavioural therapy (CBT) was the most common intervention conducted by the researchers. Clinical psychologists and trainee psychologists were the most professionals involved in the therapy. The length of therapy ranged from six weeks to three months. Discussion: Psychological interventions were more effective in reducing psychological impacts of tinnitus than non-psychological interventions such as the use of tinnitus maskers. Nevertheless, the combination of the treatments yielded more superior outcomes. Conclusion: A simplified version of psychological intervention that can be implemented by other clinical professionals should be developed to treat tinnitus holistically to overcome the shortage number of clinical psychologists.

Terapia cognitivo-comportamental em pacientes neurológicos: uma revisão sistemática / Cognitive-behavioral therapy in neurological patients: a systematic review

Pacientes neurológicos frequentemente apresentam alterações emocionais e comportamentais. O uso da terapia cognitivo-comportamental (TCC) tem sido sugerido para manejar sintomas de depressão e de ansiedade nessa população. O objetivo dessa revisão sistemática foi o de verificar a aplicabilidade da TCC em pacientes com AVC, TCE e epilepsia. Verificaram-se as bases de dados PUBMED, LILACS, Scielo Brasil, SCOPUS, PsycINFO e EMBASE. Analisaram-se artigos empíricos, redigidos em inglês, espanhol ou português, com população adulta e publicados entre os anos 2002 e 2013. Dentre os 1397 artigos encontrados, avaliaram-se 21 trabalhos. A população mais investigada foi a de TCE e o principal objetivo da TCC foi para promover melhora nos sintomas depressivos. De acordo com os resultados, a TCC em pacientes neurológicos sugere ser aplicável, porém necessita de investigações que forneçam evidências de efeito terapêutico mais confiáveis, protocolos mais estruturados, assim como estudos de follow up.

Patients with neurological damage often have emotional and behavioral changes. The use of cognitive behavioral therapy (CBT) has been suggested to manage symptoms of depression and anxiety in this population. The aim of this systematic review was to determine the applicability of CBT in patients with stroke, TBI and epilepsy. The databases PubMed, LILACS, SciELO Brazil, SCOPUS, PsycINFO, and EMBASE were consulted. Analyzed empirical articles, written in English, Spanish or Portuguese, with adults and published between 2002 and 2013. Among the 1397 articles found, 21 studies were evaluated. The population with the largest number of studies was TBI and the main goal of CBT is to promote improvement in depressive symptoms. According to the results, CBT in neurological patients suggests positive results, but requires investigations that provide evidence of therapeutic effect more reliable, more structured protocols, as well as follow-up studies.

Principales desarrollos y enfoques sobre alianza y relación terapéutica / Major developments and approaches on alliance and therapeutic relationship

Existe un consenso general de que una parte importante del éxito de un tratamiento psicoterapéutico depende de la relación entre paciente y terapeuta. Los diferentes modelos psicoterapéuticos conceptualizan la relación terapéutica de diversas maneras; en par t icular, dicho concepto presenta importantes diferencias entre la perspectiva psicoanalítica y la cognitivo-conductual. En el presente artículo, se intenta reseñar dichas diferencias en la literatura pertinente proponiendo, de este modo, una actualización del estado de conocimiento sobre el tema. En función de ello, se mencionan los principales antecedentes históricos del concepto de relación terapéutica y las líneas clásicas y actuales de investigación sobre el mismo. Para ello se realizó una revisión bibliográfica de los trabajos disponibles en las bases de datos EBSCO y Jstore. Las palabras clave utilizadas son: Relación Terapéutica, Alianza Terapéutica, Psicoanálisis, TCC. Se tomaron en cuenta principalmente los trabajos realizados a partir de 1990.

There is general consensus that an important part of the success of psychotherapy depends on the relationship between patient and therapist. Psychotherapeutic models conceptualize the therapeutic relationship in various ways; in particular, this concept has important differences between the psychoanalytic perspective and the cognitive-behavioral one. In this article, we attempt to outline the differences in the relevant literature and update the state of knowledge on this subject. According to these objectives, we discussed the main historical background of the therapeutic relationship and the classic and current lines of research on it. This article is a literature review of the information available in EBSCO and Jstore databases. The keywords used are: therapeutic relationship, therapeutic alliance, Psychoanalysis, CBT. We used data that was published after 1990.

Uma intervenção cognitivo-comportamental com uma criança com dificuldades alimentares: Pedro descobriu que gostava de comer / A cognitive-behavioural intervention in a child with feeding problems: Peter discovered that he enjoys eating

Este artigo visa descrever a intervenção com uma criança de 7 anos de idade com problemas alimentares: Pedro recusava-se a comer alimentos sólidos desde bebê. A intervenção baseou-se nos princípios cognitivo-comportamentais, incluindo treino parental e exposição gradual aos alimentos evitados, seguida de reforço positivo. Contudo, na fase final, seguiu-se uma orientação narrativa, no sentido de promover a consolidação da mudança, por meio da elaboração de resultados únicos e validação social da mudança. O comportamento alimentar de Pedro melhorou ao longo das 13 sessões. Vale destacar que os ganhos se mantiveram até a última consulta de follow-up que aconteceu 6 meses depois da finalização.

This case study aims to describe an intervention with a 7-years-old child with feeding problems: Pedro refused to eat any solid food since he was a baby. The intervention was based on cognitive-behavioural principles and included parental training and exposure to the avoided aliments followed by positive reinforcement. In the final stage, however, the intervention was inspired by the narrative therapy, in order to consolidate the change. This phase included elaboration of unique outcomes and social validation of the change. The child's feeding behaviour considerably improved throughout the 13 sessions. The positive changes have been maintained until the last follow-up session, 6 months after de finalization.

Effects of CBT on children with disruptive behaviour disorders: findings from a Singapore study

Objective: The study examines the effectiveness of a CBT treatment programme over and above that of Treatment As Usual (TAU), with children who were referred to an outpatient child psychiatric clinic for disruptive behaviour disorders in Singapore. Methods: One hundred and three children aged 8 to 12 (mean±SD=10.22±1.31) who participated in the study were assigned to either the CBT+TAU (n= 51) or TAU group (n=52). Children in both the CBT+TAU and TAU groups received a standard and typical service offered to children at the outpatient child psychiatric clinic. In addition, children in the CBT+TAU group attended the CBT treatment programme that consisted of nine 1.5 hour weekly sessions. Results: Findings from ANCOVA indicated that children in the CBT+TAU treatment group showed significantly lower levels of aggression and significantly lower levels of parental stress at posttreatment and at 3-month follow-up in comparison to the TAU group. Conclusions: Findings from the present study provided some evidence of the effects of CBT in reducing aggressive behaviour and parental stress among children with disruptive behaviour disorders. Interpretation of the findings, recommendations for future research, and implications of the present study were presented.